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How to Choose a Clinical Consultation Group (Before You Get Burned Again)

Hello Colleagues!

So you've decided to look for a clinical consultation group.

Maybe it was a specific case. One of those “oh crap” moments where you realized you had no one to run it by. Maybe it was quieter than that. Just the slow recognition that you've been making every clinical decision alone for a long time now.

Either way, you typed “consultation groups for therapists” into Google or AI, and now you're staring at a list of options with no real way to tell a good room from a bad one.

And if I'm being honest about what I hear from clinicians every week, there's usually something else going on underneath that search.

You're not just looking for a group. You're trying not to end up in another bad one.

Maybe you've been in a group where one person dominated every session. Or the facilitator was passive, or there wasn't one at all, and the whole thing devolved into venting. Maybe people rotated in and out so often you never built enough trust to bring a real question. Maybe you shared something vulnerable once and regretted it.

If any of that is you, I want to say this clearly: your hesitation isn't a flaw. It's information.

A bad group isn't a neutral experience for a therapist. It teaches you that seeking support is dangerous. So of course you're cautious. That caution is earned.

But here's the reframe I want to offer you.

The question isn't whether to join a group. The question is how to evaluate one the way you'd evaluate anything else that matters in your practice. With clear criteria and your clinical judgment fully switched on.

After facilitating hundreds of consultation sessions since 2020, and hearing story after story about the groups that hurt people before they found a good one, I can tell you that the groups that actually work all share the same five ingredients.

Let me walk you through them, including the red flags that tell you an ingredient is missing.

1. The same people, over time

Trust compounds. That's the whole mechanism.

The reason you'll eventually bring your realest questions to a consultation group, the messy countertransference, the imposter syndrome moment, the case you're embarrassed to be stuck on, is that the same people have heard your work for months. They know you. You know them. You've watched how they handle other people's vulnerability, and they've earned yours.

A rotating cast resets that clock to zero every single session. You end up performing competence for strangers instead of consulting with colleagues.

What it looks like when it's present:
A closed group. The same 6 to 8 clinicians at every session, with a clear membership commitment.

The red flag: “Drop in anytime!” Open enrollment year-round. A different mix of faces every meeting. If anyone can wander in, no one can be fully honest.

 

2. Skilled facilitation

Someone has to hold the room.

Not participate in it. Hold it. Draw out the quiet voices. Redirect the ones who take up too much space. Notice when someone flinches at feedback and circle back. Keep a case consultation from sliding into a venting session or, worse, a pile-on of unsolicited advice.

That is a skill. It doesn't happen by accident, and it doesn't happen by majority vote.

I've heard from so many clinicians whose “bad group experience” was really a facilitation failure. The group wasn't full of bad people. It was full of good people with no one holding the structure.

What it looks like when it's present: A named facilitator in every session, actively guiding the discussion, with a visible commitment to how members treat each other.

The red flag: “Peer-led” with no designated facilitator. Or a facilitator who is really just another participant with a Zoom link. Ask who holds the room. If the answer is “we all do,” be careful.

 

3. Curation

Here's a question worth asking about any group: who else is in the room, and how did they get there?

In a well-built group, you were placed deliberately. Someone talked with you first, learned about your practice, your populations, your experience level, and your clinical style, and then matched you with a group whose mix actually works. A blend of newer and seasoned clinicians. Different modalities. Different perspectives. That mix is where the richest consultation happens.

In a poorly built group, whoever paid first got a seat.

What it looks like when it's present: A screening or discovery conversation before you're ever placed. Every member licensed and vetted. A deliberate mix of experience and orientation.

The red flag: No conversation before joining. First-come, first-served enrollment. No idea who your groupmates are until the first session. If nobody curated the room, nobody is responsible for what happens in it.

 

4. Confidentiality

A Facebook group is not clinical consultation. Neither is any public or semi-public forum, no matter how many thousands of therapists are in it.

It's not that those spaces are evil. Some are lovely for camaraderie and memes. But consultation requires you to talk about your actual clinical work, your uncertainty, and your mistakes. You cannot do that safely in a space with no confidentiality agreement, no facilitation, and screenshots.

Real consultation happens behind a signed agreement, in a closed room, on a secure platform, inside a culture where confidentiality is honored because everyone understands exactly what's at stake.

What it looks like when it's present: A written group agreement covering confidentiality and how members show up for each other. A HIPAA-compliant meeting platform. A culture that takes it seriously.

The red flag: Anything public or semi-public presented as “consultation.” Or a private group where confidentiality is assumed rather than agreed to. Assumptions are not agreements.

 

5. Structure

The last ingredient is the least glamorous and the most protective: structure.

A predictable format. Protected, consistent meeting times. A clear sense of how cases get brought and discussed. And, this one matters more than most clinicians realize, documentation.

Regular, documented peer consultation is one of the strongest risk management practices available to a solo clinician. If a case ever goes sideways, “I consulted on this, here's when, and here's what was discussed” is worth a great deal. A group with no structure and no record can't give you that.

Structure is also what keeps a group from drifting. Sessions without an arc become social hours. Social hours are nice. They are not consultation.

What it looks like when it's present: A consistent rhythm, a clear format, and a way to document that consultation occurred.

The red flag: Meetings that meander with no format. No documentation. Sessions that regularly turn into venting. If you can't describe the structure, there isn't one.

 

IT IS OK to have standards

You are allowed to interview a group before you join it. Just like the consultation call with a potential new client. This ensures the fit is right.

You spent years developing clinical judgment. Use it here. Any group worth joining will have a facilitator willing to answer direct questions, and honestly, how they respond to your questions tells you almost everything.

Here are four questions you can ask on any discovery or screening call, word for word:

  1. “Who is in the group, and how were they chosen?”
  2. “Who facilitates, and what does that actually look like in a session?”
  3. “How is confidentiality handled? Is there a written agreement?”
  4. “What happens if the group dynamic isn't working for me?”

A good facilitator will welcome these questions. She'll answer them specifically, without defensiveness, because she's thought about every one of them long before you asked.

That's really the sixth signal, isn't it? The person holding the room should be glad you're evaluating it carefully. If your questions are treated as an inconvenience, you have your answer.

You've been trained to hold space for everyone else's needs. This is one place where you get to claim your own. Take your time. Ask your questions. Trust what you notice.

The right room exists. You're allowed to hold out for it.

 

FAQs

– Are Facebook groups okay for clinical consultation? No. Facebook groups lack confidentiality agreements, facilitation, and structure, which makes them unsafe for discussing real clinical work. They can be fine for camaraderie, but consultation requires a closed, confidential, facilitated space.

– What should I ask before joining a consultation group? Ask who is in the group and how they were chosen, who facilitates and what that looks like, how confidentiality is handled, and what happens if the group dynamic isn't working for you.

– How big should a clinical consultation group be? Small enough that everyone is known and heard, typically 6 to 8 members, with the same clinicians attending every session so trust can build over time.

– Does peer consultation help with risk management? Yes. Regular, documented peer consultation demonstrates that you sought collegial input on clinical decisions, which is one of the strongest risk management practices available to solo clinicians.

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Peer Consultation vs. Supervision: What’s the Difference, and Which Do You Need?

Dear Therapist,

Here's a sentence I hear from newly licensed clinicians all the time, usually said quietly, like a confession:

“I keep thinking ‘what would my supervisor say?' and then remembering I don't have one anymore.”

And here's the companion sentence from clinicians fifteen or twenty years in:
“I know I should be getting consultation. I just haven't found the right fit.”

Both of these point at the same gap. Supervision is the last structured support most of us ever receive, and when it ends, nothing officially replaces it. Full licensure comes with a freedom that can feel a lot like being untethered.

So let's get clear about what supervision was actually doing for you, what consultation is, and how to know which one belongs in your practice now.

What supervision is
Supervision is hierarchical by design. Your supervisor held legal and clinical responsibility for your work. They evaluated you. They signed off on your hours. The relationship existed, in part, so someone with more authority could catch what you couldn't yet see.

That structure is exactly right for a pre-licensed clinician. And it comes with something we don't talk about enough: a built-in answer to the question “who do I ask?” You always knew. It was on your calendar.

Then you got licensed. Bravo! And the calendar went quiet.

  • What consultation is
    Peer consultation is what fully licensed clinicians do to keep growing. The differences from supervision matter:
    It's non-hierarchical. You're consulting with colleagues, not reporting to an authority. Nobody signs your hours. Nobody evaluates you.
  • You keep full clinical responsibility. A consultant or consultation group offers perspectives, questions, and experience. You decide what to do with it. Your license, your judgment, your call. It's voluntary, which means it's honest. Nobody is performing competence for an evaluator. That changes what people are willing to bring into the room, and it's why consultation conversations often go deeper than supervision ever did.
  • It's ethically expected. Every major ethics code points to consultation as part of practicing responsibly, especially around gray areas, scope questions, and high-risk situations. Consultation isn't remedial. It's the standard of care.

Let me say that again in a different way: supervision is what you needed to become a clinician. Consultation is what strong clinicians use to stay sharp for the rest of their careers.

“But I don't want supervision. I just want people.”
A newer clinician said this to me once, and I've never forgotten it, because it names the thing so precisely.

Some of you reading this had supervision experiences that were wonderful. Some of you had supervisors who were checked out, or critical, or spread too thin to really see you. Either way, what you're missing now usually isn't the hierarchy. It's the other part. The part where someone knew your work, week after week, and you never had to carry a hard case entirely alone.

That part doesn't require a supervisor. It requires colleagues. Trusted ones, in a structured space, on a regular rhythm.

How to know which one you need

This one is mercifully simple.
You need supervision if you are pre-licensed and accruing hours, or your license or setting requires it, or you're adding a modality where you genuinely need someone with authority over your training (some certifications require it).

You need consultation if you are fully licensed and any of the following are true: you sit with hard cases alone, you make clinical and business decisions in a vacuum, you have a “what would my supervisor say?” reflex with no one on the other end of it, or you're doing good work and simply miss having colleagues who know you.

Notice that the second list has nothing to do with struggling. The clinicians doing the best work are almost always the ones with trusted colleagues they consult regularly. It's not a sign that something is wrong. It's a sign that you take your work seriously.

One more difference worth naming
Supervision was one perspective. One person, one orientation, one set of blind spots (they had them too).

Good group consultation gives you range. A mix of modalities, populations, and experience levels means you hear the perspective you'd never have generated yourself. Newer clinicians bring current training and questions that pull veterans back to fundamentals. Seasoned clinicians bring pattern recognition that only comes with years. Everyone gives. Everyone receives.

If you've been vaguely feeling like you should “get consultation” without knowing exactly what you're looking for, I hope this helps you name it.

You're not looking for supervision's replacement.

You're looking for what was supposed to come next.

FAQs

  • What is the difference between supervision and peer consultation? Supervision is hierarchical and evaluative: the supervisor holds responsibility for a pre-licensed clinician's work. Peer consultation is non-hierarchical and voluntary: fully licensed clinicians exchange perspectives while each retains full clinical responsibility.
  • Do licensed therapists still need consultation? Yes. Every major ethics code points to consultation as part of responsible practice, particularly for gray areas, scope-of-competence questions, and high-risk situations. It is the standard of care, not a remedial measure.
  • Does peer consultation count as supervision? No. Consultation cannot be used for supervision hours or licensure requirements. They are different structures serving different purposes.
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What Does Clinical Consultation Cost? (And What Should You Get for the Money?)

Dear Therapist,

Let's talk about money. Directly, with real numbers, because when you search “how much does clinical consultation cost,” you deserve a better answer than “it depends” followed by a contact form.

But first, I want to name something, because if you're a therapist reading a pricing article, it's probably already humming in the background.

Somewhere in graduate school, most of us absorbed two beliefs: that we'll never make real money in this field, and that clinical support should be free. Nobody said it in those words. It came through in stipends, in unpaid internships, in the culture of self-sacrifice. So when you consider paying for consultation, a voice says “you should be able to get this for free.”

That voice isn't wrong that free options exist. It's wrong about what they deliver. That's not entitlement talking, by the way. It's conditioning, and naming it is the first step to making an actual decision instead of an automatic one.

So here's the honest landscape.

Free: peer groups and online communities

What it costs: Nothing, in dollars.

What you get: Free peer consultation groups are usually unfacilitated, open-membership, and inconsistent. The research phase of building CollabOasis included hearing dozens of stories about them: one person dominates, discussion devolves into venting, members rotate so often that trust never forms. Facebook groups are a different category entirely. They can be lovely for camaraderie, but with no confidentiality agreement, no facilitation, and a public or semi-public format, they are not a place to discuss real clinical work.

The real cost: Time, and sometimes a bruise. Many clinicians who had a bad free-group experience wrote off consultation altogether. That's the most expensive outcome on this whole page.

Individual consultation: roughly $100 to $300 per session

What it costs: Most experienced consultants charge somewhere near their clinical hourly rate. Specialists and well-known names charge more.

What you get: One expert's perspective, focused entirely on you. This is genuinely valuable for a specific challenge inside that person's specialty: building a niche, an area of clinical expertise you're developing, a thorny supervision-of-supervision question.

The limitation: One perspective. One orientation. One set of blind spots. And typically no continuity unless you book ongoing sessions, at which point the math gets significant: monthly individual consultation at $150 to $200 runs $1,800 to $2,400 a year.

Facilitated group consultation: roughly $50 to $125 per session

What it costs: Structured, professionally facilitated groups generally land in this range per session, often packaged monthly.

What you get, if the group is built well: This is the key phrase, because the price only makes sense when five things are present. The same small group of clinicians over time, so trust compounds. Skilled facilitation, so the room stays safe and productive. Deliberate curation, so the mix of experience and modality actually works. Real confidentiality, in writing. And structure, including documentation, which quietly doubles as risk management.

Those five ingredients are what you're paying for. Not the Zoom link. A group missing them isn't a bargain at any price, and a group that has all five gives you something neither the free options nor individual consultation can: multiple trusted perspectives, from people who know your work, on a rhythm you can count on.

Where CollabOasis lands, specifically

Since transparency is the whole point of this post: a CollabOasis session is $100. That's the entire pricing structure.

New members join through a six-session Intensive, which is $600 in full or two payments of $300. If your group decides to continue afterward, ongoing membership is $200 per month for your two facilitated sessions plus everything around them. No enrollment fees, no tiers, and your rate stays locked for as long as you're a member.

I price it this way on purpose. One number, easy math, no games. You can compare it against every option above with real information.

Two things before you decide anything

First: consultation is a business expense, and usually a tax-deductible one. You already invest in your EHR, your liability insurance, your CE hours. Consultation belongs in that category, not in the “personal indulgence” category your grad school conditioning wants to file it under. Frame it against what you already invest in your practice, not against zero. (Your accountant can confirm the deduction for your situation.)

Second: the most expensive option is the vacuum. The clinical decision made alone and second-guessed for weeks. The business decision made scared. The imposter syndrome that compounds because no one you trust ever says “oh, me too.” None of that shows up on an invoice, which is exactly why it's easy to keep paying it.

Whatever you choose, choose it with clear eyes and real numbers. That's all I'd ever ask of a colleague.

If you're weighing options and want to talk it through with a human, that's exactly what a Discovery Chat is. Twenty minutes on Zoom, no pressure, no pitch. If CollabOasis isn't the right fit, I'll tell you honestly.

FAQs

  • How much does clinical consultation cost? Individual consultation typically runs $100 to $300 per session. Facilitated group consultation generally costs $50 to $125 per session. Free peer groups exist but usually lack facilitation, curation, confidentiality agreements, and continuity.
  • Is clinical consultation tax-deductible? For most private practice clinicians, consultation is a professional business expense and is usually tax-deductible. Confirm with your accountant.
  • Is paid consultation better than a free peer group? Payment itself isn't the point. What matters is whether the group has skilled facilitation, consistent membership, deliberate curation, written confidentiality, and structure. Those ingredients cost money to provide, which is why well-run groups are rarely free.
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Your Best Risk Management Isn’t More Insurance. It’s Documented Consultation.

Let's talk about the “oh crap” cases.

You know the ones. The client whose situation slides into an ethical gray area you've never faced. The disclosure that lands somewhere near a mandated reporting threshold but not clearly over it. The termination that could go sideways. The moment you think “I should probably run this by someone” while sitting in an office where there is no someone.

Most of us handle risk management the way we were taught: carry good liability insurance, keep thorough notes, and hope. Those matter. But insurance is protection for after something goes wrong. Today I want to talk about the layer that works before: regular, documented peer consultation.

“What would a reasonable clinician do?”

If a clinical decision of yours is ever questioned, by a licensing board, in a complaint, anywhere, the standard it gets measured against is some version of this question: what would a reasonably prudent clinician have done in the same situation?

Here's the thing about that standard. A reasonably prudent clinician facing a genuinely hard call doesn't decide entirely alone. She consults. Every major ethics code says so, in its own language: when facing ethical dilemmas, questions of scope, or high-risk situations, seek consultation.

Which means consultation isn't just comforting. It's evidence. Evidence that you took the situation seriously, sought qualified input, considered perspectives beyond your own, and made a thoughtful decision. “I consulted on this case on these dates, here were the considerations, here's the reasoning behind my decision” is one of the strongest sentences a solo clinician can have in her records.

Now the uncomfortable question: if you had to point to your consultation on your hardest current case, could you?

The vacuum is the risk

For clinicians in solo or online practice, the honest answer is often no. Not because you're careless. Because the structure disappeared.

In an agency or group practice, consultation happened almost by accident. A colleague down the hall, a team meeting, a supervisor's open door. Your hardest calls got a second set of eyes without you having to arrange it.

Solo practice quietly removed all of that, and most of us never built a replacement. So the hard decisions get made in a vacuum, at 9pm, with a browser tab open to an ethics code and a knot in your stomach.

I want to be clear: the risk isn't that you're a bad clinician. The risk is that you're a good clinician making isolated decisions with no record of input. Those are different problems, and the second one is fixable.

What “documented consultation” actually looks like

This is simpler than it sounds. Meaningful consultation documentation captures a few things:

That consultation occurred, and when. A regular rhythm matters here; consultation only when you're already in trouble looks reactive, while ongoing consultation shows a standing professional practice.

What was discussed, in de-identified terms. The type of clinical question, the considerations raised, the perspectives offered.

What you decided and why. The reasoning is the valuable part. It shows judgment, not just attendance.

If you're consulting informally now, a text thread with a trusted colleague, an occasional phone call, you're getting some of the clinical benefit and almost none of the protective benefit, because none of it is structured or documented. That's worth fixing, and it's honestly one of the easier gaps in a practice to close.

The quiet second benefit

Here's what surprises clinicians who start consulting regularly for risk management: that's not the benefit they end up valuing most.

The cases that keep you up at night get lighter when six colleagues who know your work have their hands on them too. The gray-area decision you'd have second-guessed for three weeks gets settled in forty minutes, with perspectives you'd never have generated alone. And the documentation becomes a side effect of a practice that was worth doing anyway.

Risk management gets you in the door. Not being alone with the work is why you stay.

A concrete next step

Wherever you get consultation, make it regular and make a record. If you don't currently have a consultation structure, IT IS OK that you haven't yet. Nearly every solo clinician is in the same spot, for the same understandable reasons. But let this be the nudge: pick a path this month. A standing arrangement with trusted colleagues, a facilitated group, whatever fits your practice. Your future self, sitting with next year's hardest case, will be very glad you did.

Our work is hard. It doesn't have to be lonely. And it definitely doesn't have to be undocumented.

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The invisible job in the room…Why some consultation groups work and most don’t.

If you've ever been in a consultation group that fell apart, or fell flat, I want to offer you a different way to understand what happened.

It probably wasn't the people.

It was probably the absence of facilitation.

Here's what I mean. Most peer groups start with good intentions and no structure. And without someone actively holding the room, predictable things happen:

The most confident voice takes up most of the air.

The quiet clinician (often the one with the most thoughtful read on the case) never unmutes.

Consultation drifts into venting. Venting is human and has its place, but it isn't consultation, and everyone leaves without what they came for.

Someone gives unsolicited advice with an edge to it, nobody addresses it, and the safety in the room quietly dies. People stop bringing their real questions. Then they stop coming.

Sound familiar to anyone?

Now here's what facilitation actually looks like, because most of it is invisible when it's done well. A facilitator tracks who hasn't spoken and makes room for them. Notices when a case presentation is circling and gently lands it. Redirects feedback that's drifting toward judgment. Watches the clock so the person who shared third gets as much time as the person who shared first. And holds the group agreements so firmly that vulnerability starts to feel… safe.

One of my members keeps her mic muted most of the session. When I see her unmute, I know to invite her in. That tiny thing is facilitation. Nobody else in the room even notices it happening.

So if a group burned you before, please hear this: you didn't fail at groups. You were likely in an unfacilitated room. Those are two very different things.

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Blog Psychotherapy Clinical Issues

Our field hasn’t recovered from the pandemic…

I meet with groups of therapists every single week, which gives me a bird's eye view of what's going on in our field. And lately I keep hearing the same thing, in different words, from clinicians at every career stage:

“Is it just me, or is this field getting harder?”

“I'm not sure I can keep doing this work.”

It is not just you.

The strain you're feeling is a reasonable response to a genuinely difficult season in our field. So let's name what's actually happening, because we can't address what we won't look at.

The courtroom we've all been watching

Many of us have followed the Lindsay Clancy trial. A mother, a nurse, a person who was in treatment, and three children who are gone. It is unbearable on every level, and we hold that grief first. The system failed her.

But underneath the grief, I hear something additional from clinicians: fear. Part of what played out in that courtroom was a detailed dissection of her care. What was prescribed, what was documented, what was asked and not asked. Every clinician watching has had the same quiet thought: that could be my chart on that screen.

If you've been second-guessing your risk assessments lately, or lying awake reviewing a session in your head, you are not being paranoid. You are responding to something real.

The headlines that blame us

This summer, a national publication asked whether therapists are to blame for adult children cutting off their parents. In one survey, about a third of estranged parents believed their child's therapist influenced the cutoff.

A third of those parents believe WE did that.

You and I know what actually happens in our offices. Ethical therapists don't hand out estrangement like a prescription. We help clients understand their relationships and their options, then we support their autonomy, sometimes through decisions we wouldn't have chosen for them. But that nuance doesn't make it into a headline. So we're practicing under a cultural narrative that paints us as family-wreckers, and that is exhausting in a way that's hard to explain to anyone outside our field.

The insurance grind

Then there's the piece nobody outside the medical profession sees. Claims denied by algorithms no human ever reviewed. Reimbursement rates flat or shrinking while every cost of running a practice goes up. Hours spent appealing sessions you already provided in good faith.

I want to say this plainly: fighting an AI-generated denial after a full clinical day is not a personal failure of efficiency. It is an unreasonable burden being placed on you.

The values question in the room

On top of all of this, a new wave of national coverage is questioning whether therapists steer clients with our own values and politics. It's a fair question to sit with. But the timing is brutal. Clients are bringing the political divide into session more than ever, and we're being asked to hold all of it with perfect neutrality while headlines suggest we can't be trusted to.

That is a lot to carry. And most of us are carrying it alone, in a home office, with no colleague down the hall to turn to and say “did you see that article?”

So what do we do about it?

Here's the part where I tell you that naming it matters, AND we need to act. Both things are true.

Get your consultation in place before you need it. This is the single most protective thing you can do right now, clinically and legally. Regular, documented peer consultation is how you catch blind spots in risk assessment and think through a values-loaded case before it becomes a problem. “I consulted regularly and documented it” is a very different position than “I decided alone.”

Tighten your documentation. Not out of fear. Out of self-respect. Document your risk assessments, your clinical reasoning on hard calls, and your consultations. Future you will be grateful.

Fight the denials, and report the pattern. Appeal AI-generated denials; a share of appealed claims get overturned. Then file complaints with your state insurance commissioner and report patterns to your professional association. Individual appeals fix your Tuesday. Reported patterns are how regulation eventually changes.

Add your voice. NASW, ACA, AAMFT and APA all have active advocacy efforts around reimbursement, AI in claims review, and mental health parity. Twenty minutes of participation is a genuine antidote to helplessness.

Check your own tank. Your own therapy. Your news limits. Your caseload honesty. You already know this. Consider this your permission slip to actually do it. IT IS OK to protect yourself first so you can keep doing this work.

And stop carrying it alone. Every hardship I've named gets heavier in isolation and lighter in trusted company. The clinicians who are weathering this season best are not the ones with the fewest hard cases. They're the ones with colleagues who know their work, hear their doubts, and remind them of who they are.

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Blog Psychotherapy Clinical Issues

Let’s Talk Progress Notes

Let's Talk Progress Notes

If you ask around about the aspects of clinical work that cause problems for therapists, you will probably find writing progress notes to be in the top 3.

Progress notes can be hard on clinicians for a variety of reasons:

  1. The emotional toll of the session causes you to avoid writing the note and experiencing it again.
  2. You don’t have a good system in place to make sure you are on top of your notes.
  3. You have ADHD (like me), and find it hard to get motivated to do mundane tasks.
  4. You are so far behind that overload and fear of an audit have you paralyzed.
  5. You feel insecure about what should be in the note and worry that you are not covering all of the bases.
  6. Your EHR or note-taking system is cumbersome so you avoid it.

If you fit into any of the 6 categories I have listed, read on for some tips to get caught up and stay caught up with your progress notes

  1. Emotional toll: this can be especially difficult for some niches, such as those that do work around trauma. Writing the note immediately after the session while you are still in that emotional headspace can be really helpful. Also consider doing conjoint notes where you right the note as the session occurs. Or you can leave time at the end to summarize the session with your client and write the note with them there.

  2. Need a good system: There’s nothing better than ending your work day knowing all of your notes have been written and you have filed your claims. One way of achieving this is by allowing 5 minutes between sessions to complete the note immediately. If you don’t have time for that, take a minute to jot down key words and quotes from the session to make it easier when you return to write the full note.

  3. AHDH: For those of us with ADHD brains, systems are probably a huge part of your life. Having a firm rule about when you write the note, and not allowing yourself to negotiate a different time, can be key to making note taking at the end of the session or by the end of the day can be really useful. You might also consider using voice to text input if your EHR has option.

  4. Too far behind: It happens to all of us every now and then. Whether you have too much on your plate due to the demand for mental health services due to the pandemic, or you were sick, or you have been having a hard time doing them in general, the most helpful thing to do is the stay current with your notes. If you have overdue notes from 2 weeks ago, write the notes for today and work your way back. Some EHRs will allow you to move from one note to the next so you can go back and do the missing notes easily.

  5. What should be in a note: Writing notes for liability reasons and insurance reimbursement can be very different than those you wrote at an agency or even in grad school. Do a little research. Each insurance panel will outline what needs to be in a progress note for reimbursement. Many EHRs have note templates that you can use and modify to make sure everything is covered. Consider taking an e-course by someone familiar with auditing cases so you can learn what you need to include. You might also learn some tips and short-cuts.

  6. Cumbersome EHR: The system you use should work for you and the way you practice. There are a number of choices of EHRs and testing out several to see which one works well with how you practice is important. What works for your colleague may not be a good fit for you.


    A few more tips:
  • Have a specific procedure written down that defines how and when you need to write a progress note. (Within 24 hours of session, prior to submitting the claim, etc)

  • Work with a colleague. Many people find it easier to stay on task if they are working with someone else. For AHDH brains, we call this body-doubling. Set up a time to write notes with a colleague. Or have them be your accountability partner whom you can notify when you’ve completed your notes.

  • Use the Pomodoro method to set aside uninterrupted, focused time to get them done.

  • Set aside admin time each day so you will have uninterrupted time to get the damn things done!


    If I have missed a category that causes you problems with keeping current with your progress notes, or you have a helpful tip to share, hit reply and let me know so we can learn from each other!
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Blog Psychotherapy Clinical Issues

You Get to Choose

You Get to Choose

Hello Colleagues!

As  you know, I meet with groups of amazing therapists every single week.

This gives me a bird's eye view of the things going on in our field, issues other therapists are wresting with, and some of the fallacies we are taught in grad school which simply do not serve us.

One of the topics that comes up time and again is offering sliding scale fees and/or pro bono sessions.

Should you do it? How should you do it? Etc.

As a therapist, you are a natural giver.

You were likely drawn to this field because of the support you received at some point in your life OR because of the support you needed and didn't receive at some point in your life.
You have a helper's heart and you want to serve others with your talents and skills.

And yes! That is a wonderful way to give back.

But guess what, offering reduced or free sessions is not the only way to give back.

If you are a new clinician or in a practice building mode, offering these sessions may reduce your income in a way you cannot afford.

Choosing to give back through your work is a financial decision that is personal and specific to your situation.

But offering this type of session is just ONE way to give back.

Instead, you might find it more helpful to have a break from work and do something else. Such as:

  • volunteering at a food bank or homelessness prevention shelter.
  • volunteering at your child's school
  • walking dogs and changing kitty litter at your local SPCA
  • maintaining a shelf at your local library
  • or recognize that it is not the right season for you to give more right now because as a first line worker, you are EXHAUSTED and need to give back to yourself and your family so you can continue to support your current clients.

I want to assure you that whatever you choose is right for you, IT IS OK! Trust yourself to choose what is right for you and your situation and ignore any unsolicited opinions that do not serve your best interests.

In my next post, I will talk about some ways you can give back with therapy work in a way that works with your practice.

Categories
Blog Psychotherapy Clinical Issues

Which Type of Therapist Are You?

Which Type of Therapist Are You?

Like all people, therapists come in lots of different flavors. As the facilitator of small clinical consultation groups, I have a bird’s eye view of a variety of personalities and work styles in our field. The beauty of our field is that this diversity allows us to grow and learn from each other which benefits not only the clinicians but also the clients.

 

Let’s look at a few examples of the types of clinicians out there:

 

Clinician 1: You have a big heart and sense of obligation in serving many clients to the best of your ability. Sometimes you take on too many clients for a sustainable case load. This may feel like it makes you a committed and caring clinician but it also can lead to burnout and it muddies the waters at times about who you bring into your practice and if/when/how you decide to refer out.

***If this is you, imagine, having an intimate, trusted group of colleagues who see you and help support you in making decisions about some of these blind spots. They are able to help you assess and address the need to refer out some potential clients or refer out current clients who need something different than what you offer. These colleagues value you as a clinician and understand that this is difficult for you and provide gentle support and helpful guidance in making these decisions.

 

Clinician 2: You have very clear perspectives about your scope of practice, which clients you see, your fee structure, how you get paid (private pay vs insurance vs a hybrid model). You have clear thoughts about decisions such as policies for no show/late cancellation fees but your views are shifting and you don’t know how to handle it. Your previous firmness with these things is causing issues that are becoming apparent to you. You have realized that this field is not one size fits all and that not all policies or practice structures work for your clients but you don’t quite know what to do about it.

 ***If this is you, imagine that you have regular consultation with clinicians you trust so you are able to talk these issues through knowing you will get a variety of supportive ideas and suggestions, as well as some insight about solutions you would not have thought to consider. They know you and your work and will give you space to figure this out.

 

Clinician 3: You have been doing this work a long time. You are very well regarded and effective in your clinical work. You even supervise pre-licensed clinicians with very good results. You feel confident in most of your clinical decisions. But every now and then you have a case that gives you pause. There’s a dynamic that is worrisome that you can’t quite conceptualize so you don’t reach out to a colleague because you are unclear about what you need or you worry it will impact the way others view you.

 ***If this is you, imagine leaving work with peace of mind, knowing that your clinical consultation group is meeting soon. You know they will help you process the case, offer supportive insights and differing perspectives. You love that you get to benefit from meeting with clinicians with a variety of skill sets and theoretical orientations. You trust them and know there will be no judgement about not having a specific question, or way to conceptualize the case, since we all face that at times.

 

Clinician 4: You are an experienced clinician and most days feel great about your work. But every now and then you experience imposter syndrome and feel embarrassed by it. You don’t have anyone you feel safe being vulnerable enough to sharing this with, or you worry colleagues will think less of you.

***If this is you, imagine knowing just who to process this with. Your small clinical consultation group whom you’ve grown to know and trust are able to validate this issue. They reassure you it has nothing to do with your skills. And because they know you, they are able to offer suggestions to help you feel more confident in your work.

 

Clinician 5: You are well-rounded, have built the perfect private practice for yourself and love doing this work. But as a solo or online therapist, you find yourself feeling lonely. You miss the camaraderie of having colleagues down the hall to chat with, get clinical advice or get support with cases where you are doing good work but the client’s circumstances are difficult and you worry that you should be doing more (even though logically you know you are doing a great job with a sucky situation).

***If this is you, imagine showing up to your consultation group and sharing about your case, the difficulties the client is struggling with, and your feelings that you want or need to be doing more. But your colleagues have all had similar cases and are able to offer empathy and to normalize the discomfort you are feeling. They are there to affirm you are doing good clinical work and remind you that aspects of our field, such as this, are difficult and take a toll on us.

 

That’s 5 different clinician profiles…not an exhaustive list by any means. Did you identify with one or more of these examples?

 

Do you feel stuck in needing support to address concerns like those examples but don’t know how to go about getting what you need?

 

If you are not getting clinical consultation on a regular basis or don’t have a trusted group of colleagues to consult with, commiserate with or just laugh with, you may want to consider how this type of support can help you level up as a clinician and help you love your work even more.

Categories
Blog Psychotherapy Clinical Issues

5 Things Every Private Practice Clinician Should be Mindful Of

5 Things Therapists in Private Practice Need to be Mindful Of

As I shifted into private practice work years ago, I stumbled upon some things that were the norm where I worked but I eventually realized were not working for me. The insight came when I was completely burnt out and very unhappy with my workplace dynamics.

 

I hope these tips will help you avoid some of the angst I experienced as I transitioned into private practice.

 

So here are my recommendations for 5 Things Every Private Practice Clinician Should be Mindful of:

  1. Lunch – You should eat lunch every day or at least take some breaks between clients. I used to see 12 clients back to back and only had lunch or a break if someone cancelled. It's tempting to overschedule to allow for cancellations but this is not a healthy solution. This leads to burnout fast!
  2. End sessions on time –If you are coming from agency work where there are often different expectations about how long sessions or client work should last, learning to end on time can be challenging. Figure out how to begin wrapping up your session at least 5 minutes before the session ends. This can be done by beginning a recap of the session or with a phrase you use. “Well, I see we are out of time today” is not my favorite but if it works for you, great! There will obviously be times when a session needs extra time but that should be the exception instead of the rule.
  3. Handling no shows and late cancellations – Decide what your policy is or learn about the policy where you work, and check in with your values. Does this policy feel fair to you? Would you be OK with this policy being in place with a provider you see? Are there times you can choose to make an exception? Getting clear in your mind about this with yourself and with your clients is a must do. Holding boundaries is important but there may be times you decide to waive your policy or choose not to charge for them at all. Just be really clear with yourself and your client about why you are waiving it and about the expectation moving forward.
  4. How you feel about reducing rates – This was a doozy for me at one time. I had to define when and at what rate I would reduce to for clients in need. The last thing you want to do is give someone a reduced rate, with no time-limit to reassess the need, and then feel trapped and annoyed because they keep telling you about the new shoes they just bought. (Yes, this happened to me.) If you are gifting a reduced rate, set a time period to reassess the need then understand that their values may differ from yours around how they spend their money.
  5. Set boundaries around your schedule – In the early days especially, it's easy to take clients whenever they are available. Over time though, this can create chaos in your life. Set your schedule and stick to it (emergencies aside of course). And remember, it is perfectly OK to change your schedule to accommodate your life. Clients sometimes need to change their appointment to accommodate their lives and with enough notice, you can do that too.

I fully recognize that there are LOTS of opinions out these about these things. The bottom line for me is, check your values, be super clear to yourself and your clients about the parameters, and understand that others will do it differently.

 

Different is OK.

 

It's nice to learn about other options for managing some of these things but ultimately, you need to practice in a way that works for you!

 

******************************************

 

Due to repeated requests, I am forming BRAND NEW groups for pre-licensed therapists!

 

These groups will run just like my current CollabOasis consultation groups except all group members will be pre-licensed. Members participate in closed, facilitated groups of 6-8 clinicians who meet virtually twice a month to get consultation on cases, discuss ethics, get business tips and resources, and find supportive colleagues you will get to know and trust.

 

The focus of these groups is on supporting each other and creating a place of benevolence to establish trust and get the clinical support that is so vital in our work.

 

The monthly fee includes 2 small group meetings per month. And once you are licensed, you will get 6 months at a reduced rate for the groups for fully licensed members as you work at or build a private practice.

 

**Please note, these hours will not count towards licensure since this is not supervision.

 

If you want to learn more about it, please set up a chat with Jeanene by clicking on the Contact Us tab of this website.